Joost M Costerus1, Matthijs C Brouwer1, Marieke E S Sprengers2, Stefan D Roosendaal2, Arie van der Ende3,4, Diederik van de Beek1. 1. Department of Neurology, Academic Medical Center, Amsterdam Neuroscience, The Netherlands. 2. Department of Radiology, Academic Medical Center, Amsterdam Neuroscience, The Netherlands. 3. Department of Medical Microbiology, Academic Medical Center, Amsterdam Neuroscience, The Netherlands. 4. Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam, The Netherlands.
Abstract
Background: It is unclear how often lumbar puncture (LP) is complicated by cerebral herniation in patients with bacterial meningitis and whether cranial computed tomography (CT) can be used to identify patients at risk for herniation. Methods: We performed a nationwide prospective cohort study of patients with community-acquired bacterial meningitis from 2006 to 2014 and identified patients with clinical deterioration possibly caused by LP. For systematic evaluation of contraindications for LP on cranial CT, these patients were matched to patients in the cohort without deterioration. Four experts, blinded for outcome, scored cranial CT results for contraindications for LP. A Fleiss' generalized κ for this assessment was determined. Results: Of 1533 episodes, 47 (3.1%) had deterioration possibly caused by LP. Two patients deteriorated within 1 hour after LP (0.1%). In 43 of 47 patients with deterioration, cranial CT was performed prior to LP, so CT results were matched with 43 patients without deterioration. The interrater reliability of assessment of contraindications for LP on cranial CT was moderate (Fleiss' generalized κ = 0.47). A contraindication for LP was reported by all 4 raters in 6 patients with deterioration (14%) and in 5 without deterioration (11%). Conclusions: LP can be performed safely in the large majority of patients with bacterial meningitis, as it is only very rarely complicated by cerebral herniation. Cranial CT can be considered a screening method for contraindications for LP, but the interrater reliability of this assessment is moderate.
Background: It is unclear how often lumbar puncture (LP) is complicated by cerebral herniation in patients with bacterial meningitis and whether cranial computed tomography (CT) can be used to identify patients at risk for herniation. Methods: We performed a nationwide prospective cohort study of patients with community-acquired bacterial meningitis from 2006 to 2014 and identified patients with clinical deterioration possibly caused by LP. For systematic evaluation of contraindications for LP on cranial CT, these patients were matched to patients in the cohort without deterioration. Four experts, blinded for outcome, scored cranial CT results for contraindications for LP. A Fleiss' generalized κ for this assessment was determined. Results: Of 1533 episodes, 47 (3.1%) had deterioration possibly caused by LP. Two patients deteriorated within 1 hour after LP (0.1%). In 43 of 47 patients with deterioration, cranial CT was performed prior to LP, so CT results were matched with 43 patients without deterioration. The interrater reliability of assessment of contraindications for LP on cranial CT was moderate (Fleiss' generalized κ = 0.47). A contraindication for LP was reported by all 4 raters in 6 patients with deterioration (14%) and in 5 without deterioration (11%). Conclusions: LP can be performed safely in the large majority of patients with bacterial meningitis, as it is only very rarely complicated by cerebral herniation. Cranial CT can be considered a screening method for contraindications for LP, but the interrater reliability of this assessment is moderate.
Authors: Joost M Costerus; Cynthia M C Lemmens; Diederik van de Beek; Matthijs C Brouwer Journal: Clin Infect Dis Date: 2020-06-10 Impact factor: 9.079
Authors: David Luque-Paz; Matthieu Revest; François Eugène; Sarrah Boukthir; Loren Dejoies; Pierre Tattevin; Pierre-Jean Le Reste Journal: Open Forum Infect Dis Date: 2021-04-29 Impact factor: 3.835